Abstract
Summary
Arrhythmia, pneumonia, cardiac insufficiency, a high leukocyte count, and low albumin concentrations were associated with increased 30-day mortality in elderly hip fracture patients after surgery. It is important to improve short-term survival rates by optimizing the respiratory and cardiac function of geriatric patients before they undergo surgery.
Introduction
This study aims to investigate the 30-day mortality and related risk factors for elderly patients following surgery for hip fractures.
Methods
This retrospective study examined chart reviews for evaluating associations of gender, age, fracture site, biochemical indicators, pre-surgery comorbidities, number of pre-surgery comorbidities, time to surgery and anesthesia and surgery methods with postoperative 30-day mortality in elderly hip fracture surgery patients.
Results
A total of 1,004 patients were included in the study and 43 (4.3%) patients died within 30 days after surgery. Univariate analysis showed that patients in the non-survival group had a higher mean age, higher leukocyte counts, lower hemoglobin and albumin levels, a higher proportion of arrhythmias, pneumoniae and cardiac insufficiency and number of presurgical comorbidities than the survival group (all P-values < 0.05). Multivariate logistic analysis further confirmed that arrhythmia (OR = 2.033, P = 0.038), pneumonia (OR = 2.246, P = 0.041), cardiac insufficiency (OR = 2.833, P = 0.029), high leukocyte count (OR = 1.139, P = 0.009), and low albumin (OR = 0.925, P = 0.041) were all significant risk factors for mortality 30 days after surgery.
Conclusions
This study demonstrates that arrhythmia, pneumonia, cardiac insufficiency, a high leukocyte count, and low albumin concentrations were associated with increased 30-day mortality in elderly hip fracture patients after surgery.
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Availability of data and material
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Code availability
Not applicable.
References
Roche JJ, Wenn RT, Sahota O, Moran CG (2005) Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ 331(7529):1374. https://doi.org/10.1136/bmj.38643.663843.55
Radcliff TA, Henderson WG, Stoner TJ, Khuri SF, Dohm M, Hutt E (2008) Patient risk factors, operative care, and outcomes among older community-dwelling male veterans with hip fracture. J Bone Joint Surg Am 90(1):34–42. https://doi.org/10.2106/jbjs.g.00065
Cooper C, Campion G, Melton LJ 3rd (1992) Hip fractures in the elderly: a world-wide projection. Osteoporos Int 2(6):285–289. https://doi.org/10.1007/bf01623184
Meyer HE, Tverdal A, Falch JA, Pedersen JI (2000) Factors associated with mortality after hip fracture. Osteoporos Int 11(3):228–232. https://doi.org/10.1007/s001980050285
Pollock FH, Bethea A, Samanta D, Modak A, Maurer JP, Chumbe JT (2015) Readmission within 30 days of discharge after hip fracture care. Orthopedics 38(1):e7-13. https://doi.org/10.3928/01477447-20150105-53
Karres J, Kieviet N, Eerenberg JP, Vrouenraets BC (2018) Predicting early mortality after hip fracture surgery: the Hip Fracture Estimator of Mortality Amsterdam. J Orthop Trauma 32(1):27–33. https://doi.org/10.1097/bot.0000000000001025
Cahueque M, Martínez M, Cobar A, Bregni M (2017) Early reduction of acetabular fractures decreases the risk of post-traumatic hip osteoarthritis? J Clin Orthop Trauma 8(4):320–326. https://doi.org/10.1016/j.jcot.2017.01.001
Bjørgul K, Reikerås O (2007) Outcome of undisplaced and moderately displaced femoral neck fractures. Acta Orthop 78(4):498–504. https://doi.org/10.1080/17453670710014149
Lawrence VA, Hilsenbeck SG, Noveck H, Poses RM, Carson JL (2002) Medical complications and outcomes after hip fracture repair. Arch Intern Med 162(18):2053–2057. https://doi.org/10.1001/archinte.162.18.2053
Giversen IM (2007) Time trends of mortality after first hip fractures. Osteoporos Int 18(6):721–732. https://doi.org/10.1007/s00198-006-0300-1
Farahmand BY, Michaëlsson K, Ahlbom A, Ljunghall S, Baron JA (2005) Survival after hip fracture. Osteoporos Int 16(12):1583–1590. https://doi.org/10.1007/s00198-005-2024-z
Khan MA, Hossain FS, Ahmed I, Muthukumar N, Mohsen A (2013) Predictors of early mortality after hip fracture surgery. Int Orthop 37(11):2119–2124. https://doi.org/10.1007/s00264-013-2068-1
Lau TW, Fang C, Leung F (2016) Assessment of postoperative short-term and long-term mortality risk in Chinese geriatric patients for hip fracture using the Charlson comorbidity score. Hong Kong Med J 22(1):16–22. https://doi.org/10.12809/hkmj154451
Choi HJ, Kim E, Shin YJ, Choi BY, Kim YH, Lim TH (2014) The timing of surgery and mortality in elderly hip fractures: a retrospective, multicenteric cohort study. Indian J Orthop 48(6):599–604. https://doi.org/10.4103/0019-5413.144232
Nordström P, Gustafson Y, Michaëlsson K, Nordström A (2015) Length of hospital stay after hip fracture and short term risk of death after discharge: a total cohort study in Sweden. BMJ 350:h696. https://doi.org/10.1136/bmj.h696
Koh GC, Tai BC, Ang LW, Heng D, Yuan JM, Koh WP (2013) All-cause and cause-specific mortality after hip fracture among Chinese women and men: the Singapore Chinese Health Study. Osteoporos Int 24(7):1981–1989. https://doi.org/10.1007/s00198-012-2183-7
Penrod JD, Litke A, Hawkes WG, Magaziner J, Doucette JT, Koval KJ, Silberzweig SB, Egol KA, Siu AL (2008) The association of race, gender, and comorbidity with mortality and function after hip fracture. J Gerontol A Biol Sci Med Sci 63(8):867–872. https://doi.org/10.1093/gerona/63.8.867
Physicians RCo, (2014) National Hip Fracture Database (NHFD) annual report 2014. Royal College of Physicians, London
Hietala P, Strandberg M, Strandberg N, Gullichsen E, Airaksinen KE (2013) Perioperative myocardial infarctions are common and often unrecognized in patients undergoing hip fracture surgery. J Trauma Acute Care Surg 74(4):1087–1091. https://doi.org/10.1097/TA.0b013e3182827322
Nettleman MD, Alsip J, Schrader M, Schulte M (1996) Predictors of mortality after acute hip fracture. J Gen Intern Med 11(12):765–767. https://doi.org/10.1007/bf02598997
Padrón-Monedero A, López-Cuadrado T, Galán I, Martínez-Sánchez EV, Martin P, Fernández-Cuenca R (2017) Effect of comorbidities on the association between age and hospital mortality after fall-related hip fracture in elderly patients. Osteoporos Int 28(5):1559–1568. https://doi.org/10.1007/s00198-017-3926-2
Norring-Agerskov D, Madsen CM, Bathum L, Pedersen OB, Lauritzen JB, Jørgensen NR, Jørgensen HL (2019) History of cardiovascular disease and cardiovascular biomarkers are associated with 30-day mortality in patients with hip fracture. Osteoporos Int 30(9):1767–1778. https://doi.org/10.1007/s00198-019-05056-w
Adunsky A, Arad M, Koren-Morag N, Fleissig Y, Mizrahi EH (2012) Increased 1-year mortality rates among elderly hip fracture patients with atrial fibrillation. Aging Clin Exp Res 24(3):233–238. https://doi.org/10.1007/bf03325251
Sofu H, Üçpunar H, Çamurcu Y, Duman S, Konya MN, Gürsu S, Şahin V (2017) Predictive factors for early hospital readmission and 1-year mortality in elder patients following surgical treatment of a hip fracture. Ulus Travma Acil Cerrahi Derg 23(3):245–250. https://doi.org/10.5505/tjtes.2016.84404
Sennerby U, Melhus H, Gedeborg R, Byberg L, Garmo H, Ahlbom A, Pedersen NL, Michaëlsson K (2009) Cardiovascular diseases and risk of hip fracture. JAMA 302(15):1666–1673. https://doi.org/10.1001/jama.2009.1463
Jansen S, Bhangu J, de Rooij S, Daams J, Kenny RA, van der Velde N (2016) The association of cardiovascular disorders and falls: a systematic review. J Am Med Dir Assoc 17(3):193–199. https://doi.org/10.1016/j.jamda.2015.08.022
Wang S, Han Y, Qian X, Hou Y, Xue Q, Liu X, Liu J (2002) Clinical features of multiple organ failure in the elderly: a report of 1605 cases. Chin J Mult Organ Dis Elderly (Chin) 1 (7–10)
Bohl DD, Sershon RA, Saltzman BM, Darrith B, Della Valle CJ (2018) Incidence, risk factors, and clinical implications of pneumonia after surgery for geriatric hip fracture. J Arthroplasty 33(5):1552-1556.e1551. https://doi.org/10.1016/j.arth.2017.11.068
Hahnel J, Burdekin H, Anand S (2009) Re-admissions following hip fracture surgery. Ann R Coll Surg Engl 91(7):591–595. https://doi.org/10.1308/003588409x432374
Hindmarsh D, Loh M, Finch CF, Hayen A, Close JC (2014) Effect of comorbidity on relative survival following hospitalisation for fall-related hip fracture in older people. Australas J Ageing 33(3):E1-7. https://doi.org/10.1111/j.1741-6612.2012.00638.x
Moran CG, Wenn RT, Sikand M, Taylor AM (2005) Early mortality after hip fracture: is delay before surgery important? J Bone Joint Surg Am 87(3):483–489. https://doi.org/10.2106/jbjs.d.01796
Tosteson AN, Gottlieb DJ, Radley DC, Fisher ES, Melton LJ 3rd (2007) Excess mortality following hip fracture: the role of underlying health status. Osteoporos Int 18(11):1463–1472. https://doi.org/10.1007/s00198-007-0429-6
Hu F, Jiang C, Shen J, Tang P, Wang Y (2012) Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury 43(6):676–685. https://doi.org/10.1016/j.injury.2011.05.017
Montero Pérez-Barquero M, García Lázaro M, Carpintero Benítez P (2007) Malnutrition as a prognostic factor in elderly patients with hip fractures. Med Clin (Barc) 128(19):721–725. https://doi.org/10.1157/13106126
Incalzi RA, Capparella O, Gemma A, Camaioni D, Sanguinetti C, Carbonin PU (1994) Predicting in-hospital mortality after hip fracture in elderly patients. J Trauma 36(1):79–82. https://doi.org/10.1097/00005373-199401000-00012
Dore MP, Pes GM, Bibbò S, Tedde P, Bassotti G (2018) Constipation in the elderly from Northern Sardinia is positively associated with depression, malnutrition and female gender. Scand J Gastroenterol 53(7):797–802. https://doi.org/10.1080/00365521.2018.1473485
Bohl DD, Shen MR, Hannon CP, Fillingham YA, Darrith B, Della Valle CJ (2017) Serum albumin predicts survival and postoperative course following surgery for geriatric hip fracture. J Bone Joint Surg Am 99(24):2110–2118. https://doi.org/10.2106/jbjs.16.01620
Mizrahi EH, Fleissig Y, Arad M, Blumstein T, Adunsky A (2007) Admission albumin levels and functional outcome of elderly hip fracture patients: is it that important? Aging Clin Exp Res 19(4):284–289. https://doi.org/10.1007/bf03324703
Chung AS, Hustedt JW, Walker R, Jones C, Lowe J, Russell GV (2018) Increasing severity of malnutrition is associated with poorer 30-day outcomes in patients undergoing hip fracture surgery. J Orthop Trauma 32(4):155–160. https://doi.org/10.1097/bot.0000000000001081
Ju JB, Zhang PX, Jiang BG (2019) Risk factors for functional outcomes of the elderly with intertrochanteric fracture: a retrospective cohort study. Orthop Surg 11(4):643–652. https://doi.org/10.1111/os.12512
Nielsen KA, Jensen NC, Jensen CM, Thomsen M, Pedersen L, Johnsen SP, Ingeman A, Bartels PD, Thomsen RW (2009) Quality of care and 30 day mortality among patients with hip fractures: a nationwide cohort study. BMC Health Serv Res 9:186. https://doi.org/10.1186/1472-6963-9-186
Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB (2009) Incidence and mortality of hip fractures in the United States. JAMA 302(14):1573–1579. https://doi.org/10.1001/jama.2009.1462
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Chen, X., Zhang, J., Lin, Y. et al. Risk factors for postoperative mortality at 30 days in elderly Chinese patients with hip fractures. Osteoporos Int 33, 1109–1116 (2022). https://doi.org/10.1007/s00198-021-06257-y
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DOI: https://doi.org/10.1007/s00198-021-06257-y